title: Tolerability of combined modality therapy for rectal cancer in elderly patients aged 75 years and older.
abstract: OBJECTIVE
  To determine the rate of treatment deviations during combined modality therapy for rectal cancer in elderly patients aged 75 years and older.
  
  
  METHODS
  We reviewed the records of consecutively treated patients with rectal cancer aged 75 years and older treated with combined modality therapy at Massachusetts General Hospital and Brigham & Women's Hospital from 2002 to 2007. The primary endpoint was the rate of treatment deviation, defined as a treatment break, dose reduction, early discontinuation of therapy, or hospitalization during combined modality therapy. Patient comorbidity was rated using the validated Adult Comorbidity Evaluation 27 Test (ACE-27) comorbidity index. Fisher's exact test and the Mantel-Haenszel trend test were used to identify predictors of treatment tolerability.
  
  
  RESULTS
  Thirty-six eligible patients had a median age of 79.0 years (range, 75-87 years); 53% (19/36) had no or mild comorbidity and 47% (17/36) had moderate or severe comorbidity. In all, 58% of patients (21/36) were treated with preoperative chemoradiotherapy (CRT) and 33% (12/36) with postoperative CRT. Although 92% patients (33/36) completed the planned radiotherapy (RT) dose, 25% (9/36) required an RT-treatment break, 11% (4/36) were hospitalized, and 33% (12/36) had a dose reduction, break, or discontinuation of concurrent chemotherapy. In all, 39% of patients (14/36) completed≥4 months of adjuvant chemotherapy, and 17% (6/36) completed therapy without a treatment deviation. More patients with no to mild comorbidity completed treatment than did patients with moderate to severe comorbidity (21% vs. 12%, p=0.66). The rate of deviation did not differ between patients who had preoperative or postoperative CRT (19% vs. 17%, p=1.0).
  
  
  CONCLUSIONS
  The majority of elderly patients with rectal cancer in this series required early termination of treatment, treatment interruptions, or dose reductions. These data suggest that further intensification of combined modality therapy for rectal cancer should be performed with caution in elderly patients, who require aggressive supportive care to complete treatment.
authors.affiliation: Harvard Radiation Oncology Program, Boston, MA 02114, USA.
authors.forename: Danielle N
authors.initials: DN
authors.lastname: Margalit
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Mamon
authors.forename: Marek
authors.initials: M
authors.lastname: Ancukiewicz
authors.forename: Wendy
authors.initials: W
authors.lastname: Kobayashi
authors.forename: David P
authors.initials: DP
authors.lastname: Ryan
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Blaszkowsky
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Clark
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Willett
authors.forename: Theodore S
authors.initials: TS
authors.lastname: Hong
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D059248:Chemoradiotherapy / Q000379:methods; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods / Q000592:standards; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods; D012004:Rectal Neoplasms / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents